All Americans, and certainly we Mainers, have a pressing public health emergency on our hands: the epidemic of addiction spread throughout all facets of our society. It is here right now — but it has also been with us for many years.

The most recent annual U.S. mortality figures indicate that close to 650,000 deaths are attributable to this disease and its clinical precursors. Certainly so many unnecessary deaths, in whatever form they appear among us, matter. A lot.

On Thursday, Maine Gov. Janet Mills announced the appointment of longtime Maine Medical Association executive vice president Gordon Smith to become the state's first director of opioid response. He will coordinate efforts across state agencies to fight the epidemic. Staff photo by Joe Phelan

Nearly 40 million Americans 12 and over experience addiction involving nicotine, alcohol, controlled prescription drugs or other drugs. That is more than those Americans who have diabetes, cancer or heart disease.

The public health emergency we face does not stop there. It is estimated that an additional 80 million of us engage in so-called “risky substance use”: that is, addiction-related behaviors that threaten our own and others’ health and safety. Think incidental drunken or drugged driving. The personal and social morbidity associated with risky substance use is both confounding and deeply troubling.

The extraordinary recent annual mortality count attributable to the disease of addiction can be broken down into smaller numbers associated with the use of one or another substance that leads to and perpetuate clinical addiction. For example, the big villain in terms of this annualized body count is nicotine, whose well-known alias is tobacco – it takes over 480,000 lives a year. Close to 90,000 of all addiction-related deaths each year are attributable to alcohol.

Interestingly enough, given today’s media-driven frenzy as to a national “opioid epidemic,” the smallest count of this addiction-related mortality total — some 70,000 deaths — are connected to drugs, licit and illicit. Of these, some 40,000 or so are clinically attributable to opioid and/or opiate use. The remaining 30,000 are connected to other illicit drugs such as cocaine.

Mirroring this national pattern, Maine’s drug-related body count of 376 deaths in 2016 allowed that were primarily associated with prescription opioids. The remaining 253 deaths were attributable to heroin and other non-pharmaceutical opioids, cocaine, benzodiazepines and other drugs.

In the context of all these numbers, certainly, Gov. Janet Mills is to be commended for her recent executive order directing her administration to engage aggressively the tragic reality of our state’s excessive morbidity and mortality associated with opioids.

Whether the limited allocation through the executive order of $1.6 million constitutes an effective engagement with this pressing public health challenge is to be effective remains to be seen. Certainly, the related $5.5 million allocation proposed in the governor’s biennial budget, if it is approved by the Legislature, will complement the important work funded by that initial $1.6 million.

Yet, as tragic as our state’s incidence of opioid-related morbidity and death may be, it by itself does not serve us well as the defining public health policy reference in regard to Maine’s epidemic of addiction writ large. Obviously, as is true across the nation, here tobacco is the pre-eminent killer — taking 2,400 lives — among us, while around 540 deaths each year in Maine are attributable to alcohol.

A public policy focus on addiction and its precursors, in all its varied forms, must serve as the lens through which our public health efforts are understood and acted upon. The issue is addiction itself. That deadly, chronic disease is the one that afflicts so many of our fellow citizens right now, in all its forms — not only one tragic, but smallish subset of our addiction problem as a whole.

Such a broadened, addiction-driven perspective on that pernicious, yet preventable, public health problem must be the touchstone for thinking and acting by our public servants in Augusta. Not just an “opioid epidemic” view of the matter, as tragic and hurtful as that is on its own.

William Foster of Phippsburg is retired president of the National Center on Addiction and Substance Abuse at Columbia University and the National Council on Alcoholism and Drug Dependence.

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